Physical Therapy for Parkinson’s
Most people have heard of Parkinson’s and probably even know about famous cases like Michael J. Fox. But what is Parkinson’s, and what can be done to help people with this disease who have very serious functional limitations? I’d like to go over some of the evidence-based treatment recommendations for patients with Parkinson’s and explain about a program called LSVT BIG TM that we offer at Pacific Physical Therapy.
Parkinson’s Disease is a brain disorder. Symptoms generally include tremors, stiffness, balance deficits, changes in speech, and difficulty with coordination and walking. Patients often experience a gradual worsening of symptoms over time. There is currently no cure for Parkinson’s Disease, although the fictional Gray’s Anatomy doctors seem to be getting close😉. Parkinson’s is diagnosed by a neurologist and is generally treated with medication. Patients with more severe symptoms will sometimes have brain surgery to implant a deep brain stimulator device to help control difficulties with movement.
One of the main difficulties with Parkinson’s is that there is a disconnect between perception of amplitude of a movement and actual amplitude. What does this mean? Well, without Parkinson’s, you could place a pencil on a table in front of you, close your eyes and with relative accuracy, reach for and grab that pencil without needing to feel around on the table. With Parkinson’s, patients often have a reach that falls short of their anticipated distance. The same is true for step size. This disconnect can make walking, reaching and regular daily tasks much more difficult to complete.
An Evidence Based Program
There have been many studies done to look at various exercise treatment options for patients with Parkinson’s. Tai Chi has been shown to reduce fall risk. Forceful exercise (high speed stationary cycling with 60-80% max heartrate) is shown to improve global motor function. LSVT BIG TM has been shown to result in improvements in walking speed, balance, trunk rotation, activities of daily living and Unified Parkinson’s Disease Rating Scale.
So how is LSVT BIG TM different from traditional physical therapy? Many PT offices see patients for 2-3 visits per week. An LSVT BIG TM protocol is a more intensive program with 4 consecutive days per week with daily carry over assignments and hour-long sessions. Before becoming certified in this program, I had patients who had been receiving PT treatments for long periods of time because of the degenerative nature of Parkinson’s with slower than desired progress. With this BIG program, the standard protocol is 4 weeks, with an allowance to continue up to 6 weeks if appropriate. I have personally seen rather impressive improvements in patients in the shorter, but more intense timeframe. Of course, as with most PT programs, the home exercises are extremely important with this protocol.
LSVT BIG TM exercises are very specific with emphasis on large amplitude of movement, trunk rotation and high energy throughout sessions. The exercises have options for standing, standing while holding a chair, or sitting depending on the level of safety of each individual patient. Each session also includes a large portion focused on patient specific functional tasks. The activities may seem repetitive at first, but this high repetition helps to retrain or “calibrate” the brain to make these larger movement patterns feel normal.
LSVT BIG TM is a well-researched program and LSVT global continues to promote further research to advance treatments for patients with Parkinson’s. LSVT BIG TM was modeled after a program called LSVT Loud TM, a Speech Therapy program for improving voice control. LSVT Global require therapists who are certified with them to undergo continued training as new updates and information becomes available to ensure the most up to date treatment recommendations are being utilized.
Feel free to watch a video from LSVT Global and watch the rehabiliation program in action. Click Here
At Pacific Physical Therapist, we currently have two therapists who are certified in LSVT BIG TM treatment. Alicia Gilfoy, PT, MPT has been certified since January of 2016 and Caitin Terryll, PTA became certified in October 2021 after joining our team earlier this year.
If you or someone you love suffers from Parkinson’s reach out to our Port Orchard clinic at 360-329-7052 or Click here to request an appointment and one of our staff will reach out to you.
Alicia Gilfoy PT, MPT is a physical therapist who has been treating in the outpatient orthopedic setting since 2007.
